Tag Archives: npfit

Fire ‘superstations’ without software cost £1m a month – The Times

Posted on 24/05/2012 | Leave a comment

By Tony Collins

The Times reports today that taxpayers are paying more than £1m a month on the rent and upkeep of fire control rooms across England that have never been used. The purpose-built control centres look ready for immediate use, with open-plan desks fitted with desktop monitors and keyboards, and huge screens on a wall at the front of the control rooms which are supposed to help fire and rescue crews mobilise appliances and manage incidents.

Only there’s no working software.  The Department for Communities and Local Government negotiated the end of a contract with the main contractor EADS for software to run the regional control centres in December 2010. Officials concluded that the software could not be delivered within an acceptable timeframe. The regional control centres were completed before the IT project was cancelled.

The cost of the centres has been uncovered after a request under the FOI Act. The Times devotes much of its page three to a story under the headline:

Revealed: scandal of the £1m-a-month fire service ‘superstations’ lying empty.

Only one of nine regional centres is in use. The other eight incur rent, electricity, water and repair costs at £1,134,566 a month. Costs will be incurred for years because there are no break clauses in the agreements to lease the buildings. Two leases come to an end in 2027, one in 2028, two in 2032, three in 2033 and one in 2035.

A spokesman for the Department said that agreement has been reached for a further two of the buildings to be used by local fire authorities. Officials are searching for public or private sector tenants to occupy the other regional centres.

Lord Prescott, the former Deputy Prime Minister, who authorised the start of the technology project in 2004,  said he had been kept in the dark by civil servants on the rising costs of the scheme. He said it had been on budget when he left the department in 2007.

Eric Pickles, the Communities Secretary, said the failure of Firecontrol was an “expensive reminder of why you can’t trust Labour to run anything”. But the Coalition’s coming to power has not stopped central government IT-related failures.

Why Firecontrol failed

Firecontrol  followed the same tracks to a cliff edge that have caught out civil servants, ministers and suppliers on other government  computer-related projects.

The National Audit Office and the Public Accounts Committee found that  the Firecontrol project was rushed, had little support from those who would use it, costs and complexity were underestimated, there was an over-reliance on consultants and a lack of accountability for decisions made  – or not made.

The idea was to replace 46 local control rooms with nine, linked regional centres, which would be equipped with new standardised computer systems to handle calls, mobilise equipment and manage incidents.

But the project was cancelled in December 2010 with ministers unsure the technology would ever work. The NAO estimates that £469m will be wasted on the project.

The NAO found that the scheme was “flawed from the outset”, largely because local fire and rescue officers did not want regional centres or major changes in the way they worked.  Introducing any large new system is difficult but with enthusiastic support serious problems can sometimes be overcome; but introducing a complex new system without support from those who would use it means staff will have little incentive to find ways around problems.

The NPfIT [National Programme for IT in the NHS] failed in part because it lacked support among GPs and NHS staff; and the complexity of introducing standardised technology in semi-autonomous hospitals – each one with different ways of working – was underestimated. It was the same with Firecontrol.

The complexity of introducing standardised systems in regional centres with no goodwill among staff – was underestimated.  From the start many local fire and rescue officers criticised the lack of clarity on how a regional approach would increase efficiency. “Early on, the Department’s inconsistent messages about the regionalisation of the Fire and Rescue Service led to mistrust and some antagonism,” said the NAO.

The technology project was rushed while local fire crews were excluded from project discussions. “The project progressed too fast without essential checks being completed. For example Departmental and Treasury approval was given without proper scrutiny of the project’s feasibility or validation of the estimated costs and savings,” said the Public Accounts Committee. The project went ahead before the full business case was written.

A review of the project as early as April 2004 found that the scheme was already in poor condition overall and at significant risk of failing to deliver. But the “Gateway” review report was kept secret for seven years.

Is the stage set for IT disasters in government to continue? So far the Coalition has decided, like Labour, to keep secret all internal reports on the progress or otherwise of its mega projects, including Universal Credit, though the policy on secrecy may be about to change, which Campaign4Change will report on separately.

Firecontrol – same mistakes repeated on other projects.

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Posted in Campaign4Change, change management, consultants, culture, excessive secrecy, Freedom of Information, Gateway reviews, Government IT, IT projects, IT-related failures, local government, managing change, npfit, openness and transparency, Politics, project management, public sector, public services

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Whitehall defies NAO and Cameron on publishing status of big projects

Posted on 02/05/2012 | 1 comment

By Tony Collins

Government action to cut the number of failures of big projects including those with a major ICT component has made a difference, the National Audit Office reports today.

In its report “Assurance for major projects”  the NAO is largely supportive of actions by the Government, , the Cabinet Office’s Major Projects Authority and the Treasury in setting up reviews of major high-risk projects, including ICT-based programmes, to ensure that if they are failing they are put back on track or cancelled.

The NAO says the Government’s decision to “dismantle” the NPfIT was taken after the project was assessed by the Major Projects Authority.

But the report also shows how civil servants have managed to defy a mandate from the Prime Minister, and a separate NAO recommendation in 2010, for information on the status of big ICT and other high-risk projects to be published.

Says the NAO report

“The ambition to publish project information, as part of the government’s transparency agenda, has not been met.

“Our 2010 report recommended that the government should publicly report project status. We consider that public reporting of project information is key to providing greater accountability for projects and improving project outcomes… Regular transparent reporting of performance which highlights successes and non-compliance would also help to build an enduring assurance system.”

Separately in the report the NAO says

“There has been a lack of progress on transparency.  The [Cabinet Office’s Major Projects] Authority has not yet met its commitment to publish project information in line with government’s transparency agenda. The Authority cannot deliver this objective on its own. Senior level discussions are ongoing, between Cabinet Office, HM Treasury and departments, on the arrangements for public reporting.”

Should ministers intevene to force publication?

But the NAO report does not raise the question of why ministers have not intervened to force civil servants to publish the status information on high-risk projects.

Campaign4Changehas argued that publishing status reports on big ICT projects and programmes would be the most effective single action any government could take to reduce the number of failures. (see “Comment” below)

Prime Minister’s 2011 mandate

The NAO’s 2010 recommendation for status information on major projects to be published was backed by a mandate from the Prime Minister in January 2011 which included the undertaking to “require publication of project information consistent with the Coalition’s transparency agenda”.

The House of Commons’ Public Accounts Committee has recommended that departments publish information on the state of their major IT-based projects and programmes; and the Information Commissioner has rejected civil service arguments for not publishing such information.

In addition Francis Maude, the Cabinet Office minister, said, when in opposition, that the Conservatives, if they gained power,  would publish “Gateway” review reports soon after they are completed.  Gateway reports are similar to the assurance reviews carried out for the Major Projects Authority.

Yet none of this has happened.

The “rebel” civil servants

How is it that a group of civil servants who are opposed to publishing information on the status of large risky projects can defy the Prime Minister, Francis Maude, the National Audit Office, and the all-party Public Accounts Committee? Those recalcitrant civil servants argue that assurance reviewers would not tell the whole truth if they knew their assessments would be made public.

But how do we know they tell the whole truth when the reports are kept confidential? The Information Commissioner has pointed out in the past that civil servants have a public duty to be candid and honest. If they are not because their reports are to be published, they are failing in their public duty.

Today’s NAO report says there are differences of opinion among civil servants over whether to publish status information on projects.

Says the NAO

“There has been some support for greater transparency from departments who believe that tracking and publishing major milestones could create helpful tension in the system.

“However, concerns have been raised that increased transparency could limit the value of assurance, as it could inhibit assurance reviewers and project staff holding full and frank discussions.

“Some senior project staff also have concerns that public reporting could have a negative commercial impact, and would prefer delayed rather than real-time public reporting.”

The Cabinet Office told Campaign4Change in 2010 and 2011 that instead of publishing status reports on each major project, it will publish an annual report on the state of its programmes.

But that hasn’t happened either.

Says the NAO:

“As well as the objective to publish project information, the [Major Projects] Authority has not yet met its objective to publish an annual report on government’s major projects.

“The Authority initially expected to publish an annual report in December 2011 but is now expecting the report to be published in May or June 2012. The format of the annual report, and the information it will contain, has yet to be decided.”

Comment:

Many times over the last 20 years I have said that publishing status reports on major IT-based projects and programmes would be the most effective single action any government could take to deter departments from going ahead with overly ambitious schemes that are doomed to fail. If, against good sense, impractical schemes are approved, publishing status information will make all the difference.

Permanent secretaries will not lose sleep over a failing project, but they will not want information on it published – which is why that information should be published.

Publishing status information would give civil servants a good reason to tackle weaknesses as they developed.  Permanent secretaries may not mind losing public money on a failing project or programme. They will always fear embarrassment, however.

Who is really in control of Whitehall – civil servants or No 10? David Cameron’s office has issued a mandate that requires status information on projects to be published. The NAO has issued a similar recommendation. How long can the civil service hold out against the political will?

Links:

NAO report – Assurance for major projects

Firecontrol – same mistakes repeated on other projects

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Posted in cost reduction, culture, excessive secrecy, Freedom of Information, Gateway reviews, Government IT, IT projects, IT-related failures, Major Projects Authority, openness and transparency, operational issues, private sector lessons for the public sector, project management, public sector

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Is Choose and Book failing?

Posted on 30/03/2012 | 2 comments

By Tony Collins

Choose and Book, which is one of the limited successes of the NHS National Programme for IT, may be “withering on the vine” says Pulse.

It reports that the Department of Health is investigating a fall in the proportion of GP referrals made through Choose and Book. Several PCTs have described Choose and Book as “failing”.

Pulse says that the Government’s notional target is for 90% of GP referrals to be made through Choose and Book, but the latest figures indicate usage has fallen from a high two years ago of 57%, to around 50% in January 2012

Initiated in 2004, Choose and Book is now in use in every PCT and provider organisation across the NHS in England, including many independent sector organisations that deliver services to the NHS under a standard, national contract.

Choose and Book provides patients with the offer of choice of hospital and clinic and a booked appointment.

The Department of Health told Pulse that there have been falls in use in some areas but it was committed to ‘embed Choose and Book into daily clinical practice’.

Choose and Book was classified as ‘failing and worsening’ in February board papers from Bristol, North Somerset and South Gloucestershire PCTs, says Pulse.

DH press release in 2003

A Department of Health press release on the award of a contract for an electronic booking system to Atos said in October 2003 said

“By the end of 2005, every hospital appointment will be booked for the convenience of the patient, making it easier for patients and their GPs to choose the hospital and consultant that best meets their needs.”

Pulse suggests the drop in interest may be because GP practices are no longer paid to use Choose and Book.

Through “local enhanced service” payments to GPs, primary care trusts have given family doctors a strong reason to use Choose and Book. The payments to GPs have ranged from about 50p to about £4 for every patient booked through Choose and Book. That funding is drying up.

A locum GP who commented on Pulse’s website suggests that Choose and Book will fall into disuse without financial incentives: “I couldn’t fit it [a Choose and Book appointment] into a ten minute consult what with QOF [quality and outcomes framework, part of the GP contract] the patient’s list etc – had to do referrals at the end of the day, so never used it.”

Comment

The failure of Choose and Book to reach anything like the original target of 100% use throughout the NHS shows the fallacy of paying people, in this case GPs, to use national IT systems.

New IT should be so needed that its use doesn’t depend on special payments to the end-users. Choose and Book was trumpeted by some major suppliers as a simple and obvious solution – rather like an airline reservation system; and after years of bedding down the technology works. But GPs cannot be forced to use it.

The Department of Health had considered the NPfIT  to be the centre of universe, and that doctors would want to use it for the common good.

The fact is that GPs  care only about their patients – which is as it should be – and if they consider the system detracts from the time spent with their patients the common good becomes an abstract, indeed meaningless, concept.

Choose and Book was always a good idea, a fun thing to work on. But does a 50% take-up after nine years justify the hundreds of millions spent on it? The Department of Health is hopeful the scheme will eventually succeed. But then the DH has always been confident the NPfIT would succeed.

DH to investigate fall in the use of Choose and Book – Pulse.

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Posted in Choose and Book, Government IT, IT projects, IT-related failures, managing change, NHS, npfit, operational issues, public services

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IT crisis management – an ongoing NHS case study

Posted on 20/03/2012 | 2 comments

By Tony Collins

When a public-facing go-live goes wrong should communications be neutral in tone – or accentuate the positive?

On 8 December 2011 North Bristol NHS Trust went live with the Cerner Millennium electronic patient records system under the NPfIT programme.

At first Trust staff thought the difficulties were confined to a mix-up over outpatient appointments but it later transpired that there were 16 “clinical incidents” between 1 December 2011 and 17 January 2012 that were related to the Cerner Millennium implementation.

The Trust has published regular public information notices on the benefits, expected benefits, and problems arising from the Cerner implementation.

Reassuring in tone, the notices have made no mention of anything more potentially serious than administrative “issues”:  non-existent appointments were set up and letters sent to patients in error. The notices said that though the “issues” caused disruption and frustration, patient safety had not been compromised. The Trust apologised to staff and patients.

Clinical incidents

No mention was made in the notices of staff having reported clinical incidents in which the new patient records system was a causal factor. The NHS usually categorises  each clinical incident as a  “near miss” or “actual harm”.

In Campaign4Change’s various conversations with the North Bristol Trust over the potential seriousness or otherwise of its IT problems, one thing has been clear: it is pleased with the level of public information it has given out over the problems:

–       regularly-updated messages on its website,

–       briefings to the media including interviews for regional BBC and ITV channels by Ruth Brunt, the Trust’s chief executive,

–       board papers,

–       on-time answers to requests under the Freedom of Information Act

–       leaflets and posters placed in outpatient clinics and on car parking machines explaining that the Trust was implementing a new computer system and apologising for any delays patients may experience

The Trust also gave GPs a dedicated telephone number, fax number and email address for GPs or their patients to contact for further advice.

Profuse public information

We agree that the Trust has run a diligent public information campaign; and its communications staff have always responded quickly to our calls –  and with the documents we requested. The staff were frank in answering our questions. They told us that no decision has been taken yet on whether the Trust will publish the results of an independent inquiry into the Cerner implementation.

But if the Trust doesn’t publish the lessons from its Cerner implementation, it may wish to be reminded of a warning by the Local Health Board of Merthyr Tidfil, at the top on its Clinical Incident Reporting Policy paper: –  To err is human; to cover up is unforgivable; to fail to learn is inexcusable.         

If the Trust does not publish how will others learn from its mistakes?

Accentuate the positive?

The quantity of public information released by North Bristol NHS Trust is not an issue – but how informative is  it? Does the wider culture of the Trust still force staff to accentuate the positive?

The first of the Trust’s website statements on the problems of the Cerner implementation came about five weeks after the go-live. The opening sections of the statement made no mention of any problems. Indeed a series of bullet points listed the benefits of the system:

  • Patient records will now be securely stored electronically on a single system, replacing paper records.
  • Authorised clinicians can quickly find and share information on patients and their medical history and no longer rely on paper filing records.
  • Clinicians will also be able to access records at the patient’s bedside and can input information and statistics immediately.
  • Patients will no longer have to repeat their details to different clinicians as they will be accessible in one place.
  • Tests and outpatient appointments can be set up immediately with the patient.

The Trust’s website statement went on to say that “many”wards as well as A&E at Frenchay Hospital [Bristol] are using the new system.

Only if you’ve read this far will you see a reference to problems.

“However, we have experienced some unexpected problems in the last few weeks with outpatient appointments…”

“Huge improvements”

The current media statement is, again, more upbeat than neutral.  The vague mention of problems is countered by the equally vague claim of “huge” improvements.

“At North Bristol NHS Trust we have been implementing a new electronic patient record system to replace an outdated, less efficient system. Our wards, two minor injuries units, the Emergency Department, theatres and maternity are using the new system.

“However, we have experienced some unexpected problems with some of our outpatient clinics resulting in non-existent appointments to be set up and letters sent to patients in error. Our priority is always patient safety and we are clear that this has not been compromised.

“These issues have caused disruption and frustration for our patients and our staff and we recognise that this has not delivered the level of service that we expect, and the public expect, from us. We apologise wholeheartedly for that.

“Our staff have shown real commitment, hard work and dedication to continue to deliver patient care. Our Information Management & Technology Team worked very hard to rectify these problems as quickly as possible and we have seen huge improvements.

“The system in all outpatient clinics has now been rebuilt and relaunched. These clinics are now in a position to effectively use the new electronic records system. We anticipate there will be a further transition period for staff in those clinics. We firmly believe that the new system, once fully implemented, will improve services for our patients and provide real value.”

Campaign4Change pointed out to North Bristol that board papers on the troubled Cerner implementations at Barts and The London were commendably detailed and informative.

Barts had referred breaches of government targets on waiting times, complaints from patients, delays in the reporting of statutory and other trust performance information, extra costs, losses of income because of reduced activity, and the effect of data errors. There has been little of any of this from North Bristol’s public information campaign.

Freedom of information

Indeed North Bristol has refused to answer questions that were asked under the FOI Act by D Haverstock of the South West Whistleblowers Health Action Group.

The Trust refused Haverstock’s requests for:

–        a copy of your Cerner implementation plan, including pilot

–        the criteria on which the go-live decision was taken

–       a copy of the issues log for the implementation, with a full history of closed and open items.

–        reports on Cerner Project Board/Steering Committee meetings.

The Trust did give Haverstock a vague answer to her question on whether the Trust will have to take over the running costs of Cerner from 2015 when the Department of Health’s NPfIT contract with BT ends.

The Trust said the running costs for Cerner will become the Trust’s responsibility from October 2015 – but it doesn’t know for certain what the costs will be.

“The exact costs are still being calculated, but will be around the same levels as our previous patient administration system, we estimate,” said the Trust.

North Bristol declined to answer Haverstock’s other questions because “at this time the Trust feels that to answer your questions regarding the Cerner Millennium implementation would compromise our position with BT and Cerner”.

Rightly, Haverstock challenges the Trust’s use of the word “feels”. Rejections of FOI requests should be based on facts not its feelings.

Says Haverstock in her request to the Trust for an internal review: “Subjective feelings are not a valid reason for rejecting an FOIA request. What is your objective, evidence base for rejecting this request? [Thank to Theyworkforyou.com for this information.]

Comment

Poorly-designed health IT can kill, according to a US Institute of Medicine report “Health IT and Patient Safety Building Safer Systems for Better Care” in November 2011.

The report says:

“Poorly designed health IT can create new hazards in the already complex delivery of care.

“Although the magnitude of the risk associated with health IT is not known, some examples illus­trate the concerns.

“Dosing errors, failure to detect life-threatening illnesses, and delaying treatment due to poor human–computer interactions or loss of data have led to serious injury and death …”

There’s no evidence that the problems at North Bristol have caused any harm to patients. Indeed the Trust, in reporting the clinical incidents in response to a BBC’s reporter’s FOI request, says its “robust safeguarding processes, as well as additional checks and balances in all departments” have “ensured that clinical safety was not compromised and no patients were put at risk”.

It adds: “Our priority is always patient safety and there is no indication that this has been affected.”

But would we know if patient safety had been affected? In its public information campaign the Trust has been prolific. But the accent on the positive, rather than a neutral and factual account of the specific problems, has left us with little confidence that all the truth has yet come out.

In an IT-related crisis it is not a mass of information that the public and media regard as helpful but specific answers to specific questions. Has North Bristol managed its IT-related crisis well? Up to a point, Lord Copper.

MP questions costs of North Bristol Cerner system

Sir David Nicholson challenged on North Bristol’s Cerner costs

North Bristol system has more problems than anticipated.

North Bristol hits appointment problems

Cerner system “too entrenched” to be scrapped.

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Posted in change management, health, health records, IT projects, managing change, NHS, npfit, operational issues, outsourcing, Politics, procurement, project management, public sector, public services, supplier relationships

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Lessons from “stupid” NHS IT scheme – Logica boss

Posted on 13/03/2012 | 1 comment

Some wise words from Andy Green, CE of Logica, on lessons from the NPfIT and other failures

By Tony Collins

Andy Green, CE, Logica

Andy Green, chief executive of Logica, speaking to the BBC’s Evan Davis about the NHS National Programme for IT, NPfIT, said:

“It is a stupid thing for the supply chain to have answered, and it’s a stupid thing for the customer to have asked for.”

Green was speaking on Radio 4’s The Bottom Line about corporate “cock-ups and conspiracies”. Other guests were Phil Smith, chief executive of Cisco UK and Ireland, and entrepreneur Luke Johnson.

Green, who joined Logica as CEO in January 2008, said he was in one of the bidders for the NPfIT when he was at BT.

The plan, he said, had been to put the same system into every hospital but later foundation hospitals were able to opt out of the NPfIT.

“Half way through [the NHS IT programme] foundation hospitals were invented,  and suddenly foundation hospitals did not have to go with what the NHS said at all”.

He added: “There were fundamental errors in the whole procurement process, and then real difficulty in delivering what had been promised.”

Evan Davis said the NHS IT scheme had cost billions, achieved little and had been running for years. He asked Green: “What’s the story?”

Green said some things went well including the supply of a network that connects pharmacies and doctors. But …

“What  had been promised by the supply chain was fantastic software that had not been designed yet that was going to completely revolutionise hospitals and delivering that proved to be horrendous… in the end it is foolish to set out on a programme that is going to take seven years with a fixed procurement up front, which says we all know everything about it …”

Lessons

Green spoke of the need for the supplier to understand exactly what the customer wants and whether it is deliverable before the parties agree to draw up a project specification.

“I think the world is beginning to learn about incrementalism. Let’s do something that we can all see and understand.

“Some of our clients we now work with in common teams – we call it co-management – and only when we have worked out exactly what is going to work in the client, and we can deliver, do we specify it as a project.

“Those things tend to go a lot better. We have got used to the fact that we don’t know everything.”

Luke Johnson

Luke Johnson, who is a former chairman of Channel 4, criticised IT suppliers for not getting it right often enough.  “I have bought quite a lot of projects and been involved as a customer many times… As a customer it is a very scary thing because clearly you are not an expert. Your providers are experts and yet they do not seem to be able to get it right often enough it seems to me, given how much they charge.”

Green said there is a high failure rate in the IT industry. “The client sets out one view at the beginning and then they have to change. The sensible defence to this is the partitioning into smaller items and relationships.

“We bluntly always think of our clients over the long run. You need to know people so that you can sit down and have a decent conversation. Too often when these things start to go wrong everybody runs for the contract. Experienced buyers and sellers do not do that: they run for each other and they talk it through, and they work it out, and they put it back on track.

“It’s value that matters. It’s doing something that really changes Patisserie Valerie’s business. [Luke Johnson is chairman of Patisserie Valerie.] What can you do that would transform that. If you can get that done, then if it over-runs by 20% it probably does not matter.”

Luke Johnson: “It depends how much money you’ve got.”

Lowest-price bids

Phil Smith, Cisco

Phil Smith of Cisco said government often has the biggest problems because “they squeeze so much in procurement there is little good value and goodwill left”.He said that on good projects problems are tackled by cooperation but “if every piece of value has been squeezed out before you procure it, your only option is to get something back from it”.

Beware procurement experts

Johnson said if procurement experts take control, and their mantra is to save money, it can often lead to trouble. “I fear that in many aspects of business, it gets down exclusively to price rather than value.

“Quality is out the window. They [procurement experts] can show a saving so they have justified their bonus but the supplier may be rubbish.”

Green said government is in a difficult position when a project starts to go wrong. “You are stuck in a procurement and the poor individual responsible is almost certainly facing a union or a consumer group or a doctor who doesn’t want the thing to happen anyway.”

Evan Davis made the valid point that the costs of projects in the public sector have to be underestimated to get approved. Realistic estimates would be rejected as too costly.

“… The person who is championing this project has to demonstrate to superiors that it is not too expensive. It is only by taking the cheapest bid and starting the thing off that you can sell the project higher up and of course down the line it costs a heck of a lot more.”

Luke Johnson: “We all know in many sectors there are providers that will take things at cost or even less with a view that they will somehow bulk it out and make a margin on the way. They know the client will need variations.

Innovation means taking risks

Luke Johnson: “If you want an innovative society, if you want one that is willing to take risks, to generate new technologies, new jobs, new businesses, then it involves failures and cock-ups.

“I think the British have got vastly better in recent years in accepting that as part of the journey and that is incredibly healthy.”

BBC R4’s The Bottom Line – Cock-ups and conspiracies.

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Posted in Campaign4Change, change management, Government IT, health records, IT projects, IT-related failures, managing change, managing outsourced services, NHS, npfit, operational issues, private sector lessons for the public sector, procurement, project management, supplier relationships

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Cerner system “too entrenched to be scrapped”

Posted on 22/02/2012 | 2 comments

By Tony Collins

A report by Deloitte on problematic Cerner installations at some hospitals in Australia calls for the government to appoint a chief medical information officer to oversee computer projects across the State.

The Deloitte report is a reminder that new IT in hospitals can have good – and adverse – safety implications for patients.

Obtained by the Sydney Morning Herald under Australia’s Freedom of Information Act, the Deloitte report is said to accept complaints last year that the system put patients’ health at risk by providing insufficient alerts to clinicians when messages did not reach their destination.  Deloitte found no evidence of harm to patients.

Though the Deloitte report is specific to the Cerner “FirstNet”  system as installed at some emergency departments in New South Wales, the idea of a chief medical information officer is arguably a good one for the UK where the Department of Health’s CIO (currently Katie Davis, interim Managing Director, NHS Informatics) is not responsible for the medical implications of IT go-lives in NHS hospitals.

New systems bypass the sort of regulation that helps protects the public against harm from medical devices. After hospital IT disasters there is no requirement for a genuinely independent investigation, as happens after airline crashes.

The Sydney Morning Herald [SMH] reports Deloitte as saying that the FirstNet system, which was installed to help run emergency departments across New South Wales, is chronically underfunded.

Deloitte was asked to report on the system after some hospital staff last year lost confidence in the software and returned to manual record-keeping.

Despite continuing problems and excessive time spent on data entry, the FirstNet system is too entrenched to be scrapped and the government should instead invest in bringing it up to scratch, said Deloitte.

”With some exception, FirstNet reporting is inadequate for effective governance of [emergency department] operations,” said Deloitte as reported by the SMH.

Nurses and doctors had complained that the system increased the amount of time they spent at a screen and reduced contact with patients. But the Deloitte report said more time spent on data entry ”was essential to realise the eventual benefits of an eventual [electronic medical record]”, such as greater accuracy of test results and medicine orders.

Upgrades were improving safety at some hospitals but needed to be across the state.

The government should appoint a chief medical information officer to oversee computing projects across the state, and pay for continuing development and training for FirstNet, said Deloitte.

The Health Minister, Jillian Skinner, said clinicians did not want to scrap FirstNet because they didn’t “want to start anew”.

The list of hospitals that have had serious problems after IT installations is growing, in part because the increasing use of technology in healthcare. Though hospital staff tend to learn in time to manage new systems, the unanswered question is whether patient care and treatment – and potentially their health and safety – should be damaged in an unregulated way until the problems are solved or mitigated.

Below is the UK list where it is known that the installation of new IT has caused serious disruption.  Any effect on individual patients has gone unreported:

Barts and The London

Royal Free Hampstead

Weston Area Health Trust

Milton Keynes Hospital NHS Trust

Worthing and Southlands

Barnet and Chase Farm Hospitals NHS Trust

Nuffield Orthopaedic

North Bristol.

St George’s Healthcare NHS Trust

University Hospitals of Morecambe Bay NHS Foundation Trust

Birmingham Women’s Foundation Trust

NHS Bury

**

Links:

Does Hospital IT need airline-style certification?

Hospital computer system found lacking – Sydney Morning Herald

Jon Patrick’s essay on the effectiveness and impact of Cerner’s FirstNet system in some hospitals in New South Wales.

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Posted in Cerner, health, health records, IT projects, managing change, managing outsourced services, NHS, npfit, operational issues, Politics, public sector

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CSC may cut 500 jobs after NHS write-off – end of NPfIT?

Posted on 16/02/2012 | 1 comment

By Tony Collins

CSC has confirmed in a statement to Techweekeurope that it may cut 500 jobs on its NHS account.

“We can confirm that, regrettably, we have recently started a formal 90-day consultation process in the UK which could reduce the number of people working on our NHS account by up to a maximum of 500 people,” CSC told TechWeek Europe.

“This action is necessary mainly because we have now substantially completed many key development activities with NHS, and are now moving away from a focus on development work.”

CSC told The Register that it regretted having to take put jobs at risk, but it was necessary because its NHS workload was getting smaller.

CSC has confirmed it is to write-off almost $1.5bn (£957m) as a result of its involvement in the National Programme for IT (NPfIT).

Comment:

CSC is by no means quitting the NHS. Its NPfIT contract is still in force although it remains unrevised, out of date and subject to legal discussions. CSC has large numbers of UK trusts and GP practices as customers, which will need support and upgrades. If it cuts 500 jobs this may indicate the effective end of the monolith that was the NPfIT which will continue in a much diminished, though still expensive, form, largely because of contracts between the Department of Health and BT.

It appears that the dismantling of the NPfIT has begun in earnest, thanks largely to Cabinet Office officials, its Major Projects Group, the Cabinet Office minister Francis Maude, David Cameron and the Department of Health’s Managing Director of NHS Informatics Katie Davis.

The campaign to stop a new deal being signed with CSC was led by the Conservative MP Richard Bacon, a member of the House of Commons’ Public Accounts Committee who was concerned that a new deal would not be good value for money.

It’s to be hoped that CSC will manage to find other work for the 500. The company says it hopes to achieve the job changes through voluntary redundancies and redeploying people within other parts of its business, without the need for compulsory redundancies.

Techweek europe article that includes CSC’s statement.

MP contacts No 10 and Cabinet Office over future of the NPfIT.

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Posted in Campaign4Change, IT projects, NHS, npfit, project management, public sector

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Can officials stop TPP offering gifts to GPs?

Posted on 10/02/2012 | 3 comments

By Tony Collins

On 13 July 2011 CSC gave this written assurance to NHS Connecting for Health at its headquarters in Leeds.

“CSC can confirm that its subcontractor TPP will no longer be sending out letters to practices offering  gifts in return for organising demonstrations of SystmOne.”

TPP has continued to offer gifts, and the Department of Health is now concerned enough to divulge the letters it has sent to CSC.

It can do little more, for GPs are not bound by NHS rules on the acceptance of gifts.

NHS Connecting for Health became involved after TPP sent out a letter in April 2011 offering tea at The Ritz or two tickets to a West End show of the GP choice.

“All we ask for in return is a short slot at your [local practice manager] meeting so we can demonstrate the benefits of SystmOne,” TPP said. “We’re [sic] a proven system and a real alternative to EMIS and Vision. With a third of the country’s patient records and more than 90,000 users, SystmOne is the leader in hosted clinical systems.

“Following recent success in the London area, TPP are looking to sponsor local practice manager meetings. We’ll provide lunch and refreshments for all your attendees. As a thank-you the organiser of the event will will also receive afternoon tea at The Ritz or two tickets to a West End show of their choice …Don’t wait around for an alternative that might not arrive – SystmOne is available, right here, right now…”

SystmOne is supplied to the NHS by CSC under the National Programme for IT, at a cost to taxpayers that remains confidential under NPfIT contracts. GPs can also buy the system directly under GP Systems of Choice. Some PCTs are said to be putting pressure on GP practices to replace existing systems with SystmOne.

Three months after TPP’s “tea at The Ritz” letter, on 6 July 2011, NHS Connecting for Health’s Programme Director, GP IT, wrote to CSC.

Dear Sirs

GPSoC [GP Systems of Choice] Marketing Activity by Subcontractor (TPP)

It has come to the attention of the Authority [Connecting for Health/Department of Health] that TPP have been sending letters to practices which include offers of gifts in return for organising meetings of practice managers  during which SystmOne would be demonstrated. The gifts on offer include tea at The Ritz, two tickets to a West End show and £50 of Marks and Spencer vouchers.

The activities being carried out by TPP state that they are in relation to the provision of SystmOne through GP Systems of Choice. As the Supplier of SystmOne under the Framework Agreement, the Authority requests that CSC review these activities and provides a response to the Authority, by no later than 13 July, to advise whether TPP, as their subcontractor, will be continuing with such activity.”

CSC’s Primary Care Product Executive replied on 13 July:

“CSC was not aware of such activities being undertaken by TPP and immediately entered into dialogue with TPP.

CSC can confirm that its subcontractor TPP will not be sending out letters to practices offering gifts in return for organising demonstrations of SystmOne.”

In December 2011 Campaign4Change learned that TPP was offering £25 Marks and Spencer vouchers to GPs in return for a “short slot at your meeting so we can talk to you and demonstrate the benefits of SystmOne”. By that time TPP put the number of its users at more than 100,000.

We asked the Department of Health in December 2011 whether it approved of TPP’s incentives. It replied:

“We were made aware and asked the supplier about this activity. The supplier has subsequently confirmed that they have ceased offering incentives to GPs.”

Then we learned of a TPP offer of Hotel Chocolat chocolates.

“Happy Christmas and a Happy New Year from TPP.

“To find out why 1800 GP practices have already moved to SystmOne, just call me on the number below to book your short GP demo. Book before 24th December to get a box of Hotel Chocolat chocolates on the day of your demonstration…”

This month, February 2012, TPP sent out this message:

TPP sponsorship for your practice meeting

“TPP are looking to sponsor your practice manager meeting! We’ll provide lunch and refreshments for all of your attendees. As a thank-you, the organiser of the meeting will also receive £25 Marks and Spencer vouchers! All we ask for in return is a short slot at your meeting so we can talk to your attendees and demonstrate the benefits of SystmOne to those practices not yet using it. Anyone that books a SystmOne demonstration on the day of the meeting will also recieve £25 Marks and Spencer vouchers!

“You already know all the great reasons to move to SystmOne, why not share them with other practices in your area? The more practices that move to SystmOne, the more benefits you’ll see.

“To arrange sponsorship for your next meeting and take advantage of this great offer, just contact us on the number below or reply to this email.”

We asked DH why it had suggested that the gift offers had ceased when they hadn’t. Its reply:

“The Department contacted CSC (as the GPSoC supplier) about this activity by their subcontractor TPP. CSC confirmed that TPP would cease offering gifts to GPs in return for organising demonstrations of SystmOne. We have contacted CSC about TPP’s position which is not in line with the assurances previously provided.”

We also asked the DH why it was concerned about the gifts. It did not reply directly but sent us copies of the letter it had sent to CSC, and CSC’s reply.

Is the DH powerless to stop TPP offering gifts?

TPP told Pulse this week:  “We momentarily stopped offering the incentives over Christmas but will be resuming during February … The incentives were offered only to GPs and practice managers and were completely optional.

“Our ‘Tea at the Ritz’ offer actually costs considerably less than the cost of catering for such a practice meeting. We at TPP appreciate that GPs and their staff are extremely busy and so any thank-you gifts we offer staff are simply that, a thank-you for an hour or two of their time.”

CSC has made no comment.

Pulse reports that the GP Systems of Choice framework agreement prohibits software providers from offering gifts to any servant of the authority or a PCT. The ban does not include GPs because they do not sign the framework. Suppliers can offer gifts to GPs without breaching the framework agreement says Pulse.

It quotes Dr Charlie Stuart-Buttle, a former chair of the EMIS user group and a GP in Tonbridge, Kent, as saying the incentives were an unacceptable way of going about things. It also quotes Dr Trefor Roscoe, a GP in Sheffield and former medical IT consultant, as saying the incentives were not a problem as long as the GPs felt the system in question was worth demonstrating in the first place.

Comment

Some will say that GPs are bombarded with offers of freebies from drug companies. So why does it matter if an IT company offers gifts?

Another argument is that drugs are different. GPs can stop offering drugs that become too expensive. They cannot simply stop using a GP system. It’s a big decision for any GP practice to choose a new system even with subsidies from the Department of Health under GP Systems of Choice GPs, while the GPSoC framework lasts. Any new GP system is likely to be a long-term commitment because of the disruption of changing.

GPs should surely choose their IT supplier on the basis of the facts and after shortlisting suppliers.

We dislike the expression “level playing field” but if applied here it would mean that GPs chose new systems only after demos at which all shortlisted suppliers offered tea at the Ritz or Marks and Spencer vouchers to certain GPs.

Alternatively the suppliers could agree that none offers gifts.

IT company’s tea at The Ritz offer to GPs.

Pulse article on TPP incentives

Are PCTs putting GPs under pressure to switch to SystmOne?

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Posted in change, Government IT, health, health records, managing outsourced services, NHS, npfit, outsourcing, Politics, procurement, supplier relationships

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NPfIT Cerner go-live at Bristol – Trust issues apology

Posted on 31/01/2012 | 4 comments

By Tony Collins

North Bristol NHS Trust has issued an apology on its website after problems with the implementation of a Cerner Millennium patient record system under the National Programme for IT.

Some Bristol consultants had regarded the software as installed at the Trust as “potentially dangerous”.

The Trust went live on 9 December 2011 with a Cerner patient administration system at Frenchay Hospital and Southmead Hospital that replaced two systems. But the Trust has had to revert to paper in some areas.

On its website the Trust says that its “65 wards and maternity department are all using the new system successfully”.

It accepts that it has “experienced significant problems” in outpatient clinics. It says “These problems have been caused by the incorrect set up of clinic lists, which meant staff could not access the system and errors in the data migration of existing appointments.

“As a result, some patients may have received the wrong appointment dates, no confirmation of appointment or letters being sent out in error.  Again, processes are in place to minimise further disruption to out-patient appointments and ensure patient safety.”

TheTrust says it has engineers and technicians re-building the clinics’ system or they are “in clinics correcting problems as they happen, providing solutions and resolving issues”.

The intention is that 90% of areas will be using Cerner by the end of today [31 January]. “Our aim is that by early February all outpatient clinics will be using Cerner. All other outpatient appointments are being managed via other systems and paper processes.”

The Trust says it is contacting patients by phone or letter to advise them of their current appointment slot. “We have ensured that any urgent referrals including cancer two week waits have been prioritised to ensure they are unaffected.”

It adds “During the process of correcting the issues with outpatient clinics and to support GPs and their patients we have written to them to advise them that all patients who have been referred to us either through Choose & Book, fax or Fast Track are within our appointments system.

“We have advised GPs of a dedicated telephone number, fax number and email address for GPs or their patients to contact for further advice. To provide further reassurance to patients and GPs we will keep the helpline service running until the end of February.”

Apology

The Trust says on its website:

“We apologise and would like to thank the public for their patience and our staff for their hard work and dedication in ensuring that patient safety is not compromised.

“These issues have caused disruption and frustration for our patients and our staff and we recognise that this has not delivered the level of service that we expect, and the public expect, from us.

“It has also placed extra workload on our staff, who nevertheless, remain dedicated to ensuring the best possible patient care during this period, and managing the issues that the Trust faces.

“Our Information Management & Technology Team, supported by our suppliers BT and Cerner, have been working very hard to sort out these initial issues and we are already seeing improvements.

“We remain confident that once the new system is fully implemented, it will significantly improve services for our patients and better equip us to meet future challenges.”

Meanwhile the Bristol Evening Post reports that the Chief Executive of the hospital trust, Ruth Brunt, has called for an independent inquiry into the issues surrounding the implementation of the Cerner system.

She said people who have turned up to appointments and operations that have been cancelled or were not on the system would be compensated.  A hotline has also been set up so that people can check whether their appointments are in the system.

The Bristol Evening Post also reported that reception staff had walked out due to the pressure of dealing with patients who were unhappy to find their appointments not on the new system.

“It is horrendous – what used to take us five or six clicks is currently taking 24 and we cannot access the details,” a staff member said. “The notes have not been available when people turn up.

“We have all worked hard and I am sure if it was anywhere else we would have gone on strike. The people on the ground are struggling. It is really demoralising because we are doing our best. Girls on reception are dealing with queues of people and there has been an occasion where a receptionist has walked out because they were so stressed.

“When patients call up we want to be able to help them, but at the moment we don’t know where to look.”

The employee did not believe the trust’s claims that everything would be sorted out by 13 February.

Halt Cerner implementations says MP

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IT company’s “tea at the Ritz” offer to GP leaders

Posted on 30/01/2012 | 4 comments

By Tony Collins

An IT supplier to the Department of Health and the NHS has offered “tea at The Ritz” or two tickets to a West End show to GP leaders in return for helping to organise an event that would give the company a chance to demonstrate its systems.

TPP SystmOne, which says in its marketing literature that its systems hold a third of the country’s patient records and have more than 90,000 users, has ceased to offer the incentives, the Department of Health told Campaign4Change.

“We were made aware and asked the supplier about this activity,” said a Department of Health spokesperson. “The supplier has subsequently confirmed that they have ceased offering incentives to GPs.”

TPP also offered GP leaders a £25 Marks and Spencer voucher; and wished Merry Christmas and a Happy New Year to some potential customers with an offer of a box of Hotel Chocolat chocolates.

“To find out why 1800 GP practices have already moved to SystmOne, just call me on the number below to book your short GP demo. Book before 24th December to get a box of Hotel Chocolat chocolates on the day of your demonstration …”

In its separate offer of tea at The Ritz, a TPP SystmOne manager told the senior partner of a London health centre last year that the company’s system was available free of charge through the government-funded GP Systems of Choice initiative.

“Following recent success in the London area, TP are looking to sponsor local practice manager meetings. We’ll provide lunch and refreshments for all your attendees. As a thank-you the organiser of the event will receive afternoon tea at The Ritz or two tickets to a West End show of their choice! All we ask in return is a short slot at your meeting so we can demonstrate the benefits of SystmOne.”

Parts of the NHS have clearly-defined rules on the acceptance of gifts or hospitality. NHS Sheffield tells its staff:

“All offers of hospitality should be approached with caution. Modest hospitality, for example, a drink and sandwich during a visit or a working lunch is normal and reasonable and does not require approval of a manager. Offers of hospitality relating to theatre evenings, sporting fixtures, or holiday accommodation, or other hospitality must be declined…”

The guidance adds:

“Casual gifts by contractors or others, e.g. at Christmas time, must not be in any way connected with the performance of duties …”

TPP’s offer was not against the law. If all GP system suppliers offered the same or similar incentives, though, GP leaders could be inundated. Under the government’s health service reforms GPs who form part of Clinical Commissioning Groups will take on responsibility from primary care trusts for paying for GP systems.

We asked CSC, which supplies TPP SystmOne under the National Programme for IT, whether it was aware of the incentives and whether it, or TPP, wished to comment.

“Because we are in active negotiations with the government, we are not able to comment in depth on the programme until those negotiations have concluded,” said a CSC spokeswoman who said that the same applied to TPP as “they are a supplier to us working on the National Programme”.

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Posted in Campaign4Change, Government IT, managing outsourced services, NHS, npfit, supplier relationships

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